From the Research
A Haller index of 4.0 in a patient with Pectus Excavatum indicates severe chest wall deformity that typically warrants surgical intervention. This measurement, calculated by dividing the transverse diameter of the chest by the anteroposterior diameter at the deepest point of the depression, provides an objective assessment of deformity severity. Normal values range from 2.0-2.5, with values above 3.25 generally considered the threshold for surgical consideration [ 1 ]. At 4.0, the patient likely experiences significant physiological effects beyond cosmetic concerns, including decreased cardiac output, reduced lung capacity, and exercise intolerance due to the sternum compressing the heart and lungs.
Surgical Considerations
Surgical correction options include the Nuss procedure (minimally invasive bar placement) or the Ravitch procedure (more extensive cartilage resection) [ 2 ]. These interventions aim to improve both physiological function and psychological well-being. Patients with this severity should undergo comprehensive cardiopulmonary evaluation, including pulmonary function tests and cardiac imaging, to assess functional impairment before treatment decisions are made.
Evaluation and Treatment
The Haller index has been correlated with cardiopulmonary disease in pectus excavatum, with a higher index indicating greater severity of the deformity and potential for associated cardiopulmonary dysfunction [ 1 ]. However, the predictive value of the Haller index in patients undergoing pectus bar repair for pectus excavatum has shown that it holds no correlation with age, operative time, postoperative bar infection, or length of stay [ 3 ].
Key Points
- A Haller index of 4.0 indicates severe pectus excavatum.
- Surgical intervention is typically recommended for indices above 3.25.
- Comprehensive cardiopulmonary evaluation is necessary before treatment decisions.
- The Nuss and Ravitch procedures are common surgical correction options.
- The Haller index is a useful tool but has limitations in predicting surgical outcomes.